Thomas Trauer

A New Phenomenological Survey of Auditory Hallucinations: Evidence for Subtypes and Implications for Theory and Practice

A comprehensive understanding of the phenomenology of auditory hallucinations (AHs) is essential for developing accurate models of their causes. Yet, only 1 detailed study of the phenomenology of AHs with a sample size of N ≥ 100 has been published. The potential for overreliance on these findings, coupled with a lack of phenomenological research into many aspects of AHs relevant to contemporary neurocognitive models and the proposed (but largely untested) existence of AH subtypes, necessitates further research in this area. We undertook the most comprehensive phenomenological study of AHs to date in a psychiatric population (N = 199; 81% people diagnosed with schizophrenia), using a structured interview schedule. Previous phenomenological findings were only partially replicated. New findings included that 39% of participants reported that their voices seemed in some way to be replays of memories of previous conversations they had experienced; 45% reported that the general theme or content of what the voices said was always the same; and 55% said new voices had the same content/theme as previous voices. Cluster analysis, by variable, suggested the existence of 4 AH subtypes. We propose that there are likely to be different neurocognitive processes underpinning these experiences, necessitating revised AH models.

Psychological and Social Profile of Family Caregivers on Commencement of Palliative Care

CONTEXTnPalliative care services are required to support patients who have advanced, life-threatening, noncurable disease, and their family caregivers. Comprehensive psychological and social support for bereaved family members also is expected. However, recent systematic reviews have demonstrated significant gaps in evidence-based approaches for such support. Furthermore, a comprehensive understanding of the psychological and social response to the family caregiver role is required for support to be optimized.nnnOBJECTIVESnWe sought to examine the psychological and social profile of family caregivers on commencement of receiving palliative care services.nnnMETHODSnA self-report questionnaire was administered to primary family caregivers of patients within two weeks of admission to three palliative care services in Melbourne, Australia. The questionnaire incorporated six instruments that measured 11 family caregiver-related psychosocial factors; four instruments that measured caregiver psychological distress factors; 14 mental health lifetime risk factors; and a sociodemographic questionnaire.nnnRESULTSnThree hundred and two family caregivers participated. Nearly half (44%) of the caregivers had a probable anxiety and/or depressive disorder, with 40% scoring more than the cutoff score for probable anxiety and 20% scoring more than the cutoff score for probable depression. Additionally, approximately 15% of caregivers met the criteria for pre-loss grief, and around 10% reported moderate to severe levels of demoralization. Caregivers who had a probable anxiety and/or depressive disorder also reported higher levels of pre-loss grief.nnnCONCLUSIONnThis study provides further evidence of the prevalence of poor psychosocial well-being in this population. The results reinforce the need to develop suitable strategies for psychological and social support for family caregivers.

Guidelines for the psychosocial and bereavement support of family caregivers of palliative care patients

BACKGROUNDnSupport for family caregivers, including bereavement follow-up, is a core function of palliative care. Many caregivers acknowledge positive aspects associated with the role; however a considerable proportion will experience poor psychological, social, financial, spiritual, and physical well-being and some will suffer from complicated grief. Many family caregivers have unmet needs and would like more information, preparation, and support to assist them in the caregiving role. There is a shortage of evidence-based strategies to guide health professionals in providing optimal support while the caregiver is providing care and after the patients death.nnnPURPOSEnTo develop clinical practice guidelines for the psychosocial and bereavement support of family caregivers of palliative care patients.nnnMETHODSn(1) Literature review; (2) focus groups and structured interviews with key stakeholders within Australia; (3) national and international expert opinion to further develop and refine the guidelines using a modified Delphi process; and (4) endorsement of the guidelines from key palliative care, caregiver, and bereavement organizations (national and international).nnnRESULTSnThe guidelines were developed for multidisciplinary health care professionals and clinical services commonly involved in caring for adult patients receiving palliative care in a variety of care sites throughout Australia. These consensus-based guidelines have been endorsed key Australian and international organizations.nnnCONCLUSIONSnThe guidelines may prove valuable for the international palliative care community and for generalist health care providers who occasionally care for palliative care patients. Research is recommended to explore the uptake, implementation, and effectiveness of the guidelines.

The relationship between insight and medication adherence in severely mentally ill clients treated in the community

Objective: To study the relationship between aspects of insight and medication adherence and elements of psychopathology.

The subscale structure of the Health of the Nation Outcome Scales(HoNOS)

Data from a large field trial were used to test the propositions that the HoNOS is a unidimensional scale and that the original subscale structure fits the data and is valid. Low inter-item correlations suggest that the scale in not unidimensional. Low internal consistencies of the original subscales were also found. Confirmatory factor analysis was used to test the fit of the original subscales, which was found to be poor. An alternative subscale structure is described which fits the data much better, differentiates diagnostic groups better, and accounts for movements between in-patient and out-patient status better. The implications of the findings are discussed.

Risk factors for developing prolonged grief during bereavement in family carers of cancer patients in palliative care: A longitudinal study.

CONTEXTnFamily carers of palliative care patients report high levels of psychological distress throughout the caregiving phase and during bereavement. Palliative care providers are required to provide psychosocial support to family carers; however, determining which carers are more likely to develop prolonged grief (PG) is currently unclear.nnnOBJECTIVESnTo ascertain whether family carers reporting high levels of PG symptoms and those who develop PG disorder (PGD) by six and 13 months postdeath can be predicted from predeath information.nnnMETHODSnA longitudinal study of 301 carers of patients receiving palliative care was conducted across three palliative care services. Data were collected on entry to palliative care (T1) on a variety of sociodemographic variables, carer-related factors, and psychological distress measures. The measures of psychological distress were then readministered at six (T2; n=167) and 13 months postdeath (T3; n=143).nnnRESULTSnThe PG symptoms at T1 were a strong predictor of both PG symptomsxa0and PGD at T2 and T3. Greater bereavement dependency, a spousalxa0relationship to the patient, greater impact of caring on schedule, poor family functioning, and low levels of optimism also were risk factors for PG symptoms.nnnCONCLUSIONnScreening family carers on entry to palliative care seems to be the most effective way of identifying who has a higher risk of developing PG. We recommend screening carers six months after the death of their relative to identify most carers with PG.

Prospective psychosocial monitoring of living kidney donors using the SF-36 health survey.

Background. Psychosocial assessment and monitoring of living kidney donors is not yet standard practice, despite calls for it in the literature. Methods. Psychosocial assessment of living kidney donors was performed preoperatively and 4 months postoperatively, using the SF-36 Health Survey, the Patient Health Questionnaire psychiatric assessment, and semistructured interview. Results. Assessment was acceptable to the majority of donors; 92% (44) of 48 consecutive donors completed both assessments. Preoperatively, both physical function (SF-36 Physical Component Score [PCS]) and psychosocial function (SF-36 Mental Component Score [MCS]) were significantly higher than community (state of Victoria) norms. Postoperatively, PCS and MCS fell significantly, but not below the Victorian norm. Seven donors (16%) developed adjustment disorder or anxiety disorder; their MCS were significantly lower than those without psychiatric disorder. Conclusions. It is concluded that routine psychosocial assessment performed by a psychiatrist, including the use of questionnaires, is acceptable to donors and identifies those impaired. Potential donors need to be well prepared for such assessment and well educated about the extent of physical and psychosocial impairment that might occur in the postoperative period.

A longitudinal study of distress (depression and anxiety) up to 18 months after radiotherapy for head and neck cancer.

The aim of the study was to assess symptoms of depression and anxiety in patients with head and neck cancer up to 18u2009months after radiotherapy.

The Life Skills Profile : a study of its psychometric properties

Two hundred patients with severe mental illness of mixed type were assessed by treating mental health professionals a total of 730 times with the Life Skills Profile (LSP). Confirmatory factor analyses broadly confirmed the existence of the Self-care and Non-turbulence subscales. Internal consistencies were generally good but inter-rater reliabilities were of only marginal acceptability. The fit of the data to the five subscales can be improved by reassigning two items. The Communication subscale had the poorest psychometric properties. Certain LSP scale scores were found to vary with how well and how long the rater had known the patient. Validity, which was assessed by relating LSP scores to locus of care (i.e. community or hospital), Brief Psychiatric Rating Scale (BPRS) ratings and Resource Associated Functional Level Scale (RAFLS) ratings, was good. An alternative scoring system yielded rather clearer meaning for some of the subscales.

Prospective Quality-of-Life Monitoring of Simultaneous Pancreas and Kidney Transplant Recipients Using the 36-Item Short Form Health Survey

BACKGROUNDnFew risk factors for quality-of-life outcomes of simultaneous pancreas and kidney transplant recipients are known because of a paucity of data from prospective studies.nnnSTUDY DESIGNnPretransplant assessment and prospective 3-year follow-up.nnnSETTING & PARTICIPANTSnConsecutive potential recipients at a university teaching hospital assessed by Liaison Psychiatry.nnnPREDICTORSnDemographic data; pretransplant Transplant Evaluation Rating Scale scores; current, past 12 months, and prior lifetime psychiatric disorder.nnnOUTCOMES & MEASUREMENTSn36-Item Short Form Health Survey (SF-36) scores.nnnRESULTSn37 simultaneous pancreas and kidney transplant recipients were assessed pretransplant and at 4 months posttransplant. Posttransplant at 1 year, 29 (81% of survivors); at 2 years, 26 (79% of survivors and those reaching 2 years); and at 3 years, 22 (92% of survivors and those reaching 3 years) patients were assessed. SF-36 Mental Component Summary (MCS) scores (mean pretransplant, 46.8 +/- 8.2 [SD]; 4 months, 51.7 +/- 8.5; 1 year, 50.1 +/- 9.7; 2 years, 51.8 +/- 8.9; and 3 years, 50.8 +/- 13.8) and Physical Component Summary (PCS) scores (pretransplant, 40.6 +/- 10.6; 4 months, 43.6 +/- 12.0; 1 year, 45.6 +/- 11.3; 2 years, 48.1 +/- 10.2; and 3 years, 46.8 +/- 9.1) showed sustained improvement posttransplant. MCS scores became similar to population norms. Functionally significant decreases in MCS and PCS scores were seen in 4%-21% and 8%-30% at times posttransplant. Male sex predicted higher scores at 4 months for the MCS (P = 0.003; regression coefficient, -8.28 [95% CI, -13.6 to -2.9]; effect size, 0.22) and PCS (P = 0.05; regression coefficient, -6.91 [95% CI, -13.9 to 0.9]; effect size, 0.08). Current psychiatric disorder at pretransplant evaluation predicted higher PCS scores at 4 months (P = 0.002; regression coefficient, -15.42 [95% CI, -24.6 to -6.2]; effect size, 0.22) and 1 year (P = 0.002; regression coefficient, -17.3 [95% CI, -27.9 to -6.7]; effect size, 0.29). Psychiatric disorder before the 12 months before the pretransplant evaluation predicted lower PCS scores at 4 months posttransplant (P < 0.001; regression coefficient, 14.98 [95% CI, 7.1-22.8]; effect size, 0.29).nnnLIMITATIONSnCohort size.nnnCONCLUSIONSnAlthough half experienced sustained quality-of-life improvement, up to one-third experienced a decrease. Past psychiatric disorder is a risk factor. Patients should be educated and monitored appropriately.